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Minnesota rates for HCPCS L4040

Replace Molded Thigh Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.60 / $347.60 / $347.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.15 / $347.60 / $349.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$428.55 / $500.28 / $696.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.22 / $475.27 / $500.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.55 / $1,543.55 / $4,287.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$580.13 / $614.92 / $736.76
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$916.39 / $1,480.96 / $3,375.65
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$580.13 / $580.13 / $596.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.55 / $500.28 / $2,469.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.94 / $239.49 / $535.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.94 / $239.49 / $515.29